Tag Archives: maternal health

Summary: CARD Mutually Reinforcing Institutions (CARD MRI), the Microcredit Summit Campaign, and Freedom from Hunger announced that under the “Healthy Mothers, Healthy Babies” program, some 800,000 women have received maternal health education in the past 5 months and 3600 women have received healthcare in the past 12 months. The project aims to improve maternal health alongside their microfinance services in the Philippines, accelerating achievement of UN Millennium Development Goal 5.

WASHINGTON, D.C. [September 24]—Partners in a joint-program aiming to improve maternal health in the Philippines announced today that they provided more than 800,000 women with maternal health services in the past year. CARD Mutually Reinforcing Institutions (CARD MRI), the Microcredit Summit Campaign, and Freedom from Hunger began rolling out health education in April to poor and rural communities in Luzon, Mindanao, and, notably, the Visayas, which had catastrophic destruction in the wake of Typhoon Haiyan.

With the support of program partners, CARD MRI trained more than 1,000 account officers (AOs) in 14,650 centers to deliver the health education to CARD members. The AOs educated an average of 5,000 women per day over the last five months on important maternal health issues. Each woman received two hours of instruction on simple but important lessons like the food and nutritional supplements that pregnant and young women need and the importance of giving birth in a health facility.

“Helping poor communities through financial access is undeniably important in poverty eradication,” said Marilyn M. Manila, director of the Community Development Group at CARD MRI (a Filipino microfinance institution), “but this is insufficient to reach our goal. Poor health and having no access to health care service are a big part of continuous poverty in many countries. We realize the importance of good health of microfinance institutions’ (MFIs’) clients to help them continue improve their quality of life.” Ms. Manila also chairs the MFIs for Health, a consortium of 21 Filipino MFIs committed to providing access to health care services to poor communities.

At 30 years old, CARD MRI client Barrera is eight months pregnant with her fourth child. Barrera is one of the 3,634 women who received routine gynecological examinations and 2,222 mother and baby kits at four community health fairs over the last 12 months. Berrera attend the fair in Davao this July “for the ultrasound—to be able to see my baby. It was my first time.” More than 100 healthcare providers have participated in the four health fairs, and many more will. The next health fair will take place in very rural areas of Mindanao October 2nd and 3rd.

Community health fairs are important for improving maternal health in poor, rural communities where accessing health services is a challenge. Program partners organize health fairs with support from local foundations and professional associations like the Philippines OB/GYN Society, community health workers and private health providers, as well as the government: the Department of Health, local government units, and PhilHealth (the national insurance program).

Over the last 15 years, the Philippines has improved in many key indicators such as life expectancy, access to education, and infant mortality; however, maternal mortality has remained at unacceptably high levels. Delays in accessing medical care is a key bottleneck in achieving better results for mothers and babies. With 99 days to the end of the Millennium Development Goals and the Global Goals for Sustainable Development on the horizon, this collaboration to educate about and expand access to health services is critical for meeting the needs of poor communities. This project is supported by an educational grant from Johnson & Johnson.

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About CARD Mutually Reinforcing Institutions
The CARD MRI is a group of mutually reinforcing institutions with a common goal of alleviating poverty in the Philippines and improving the quality of lives of the socially-and-economically challenged women and families towards nation building. Based in San Pablo City in Laguna in the Philippines, CARD MRI has 1,845 offices located all over the country and has program/partnership offices in Cambodia, Vietnam, Laos, Myanmar, and Hong Kong. CARD MRI has 2.99 million members and clients as of July 2015 throughout the country, continuously providing them holistic and integrated financial and social services that help uplift their lives and eventually transform them into responsible citizens for their community and their environment.www.cardmri.com

About Freedom from Hunger
Founded in 1946, Freedom from Hunger is a US-based international development organization that brings innovative and sustainable self-help solutions to the fight against chronic hunger and poverty. By partnering with local microfinance institutions (MFIs) and nongovernmental organizations (NGOs) throughout Asia, Africa and Latin America, Freedom from Hunger is reaching 5.7 million women, equipping them with resources they need to build futures of health, hope and dignity.www.freedomfromhunger.org

About the Microcredit Summit Campaign
The Microcredit Summit Campaign (the “Campaign”), a project of RESULTS Educational Fund, is the largest global network of institutions and individuals involved in microfinance and is committed to two important goals: 1) reaching 175 million of the world’s poorest families with microfinance and 2) helping 100 million families lift themselves out of extreme poverty. The Campaign convenes a broad array of actors involved with microfinance to promote best practices in the field, to stimulate the exchange of knowledge and to work towards alleviating world poverty through microfinance. In early 2016, the Microcredit Summit Campaign will host the 18th Microcredit Summit in Abu Dhabi. The agenda will focus on “Mapping Pathways out of Poverty” and will feature innovations from the Africa-Middle East Region.www.microcreditsummit.org

MDG 5: Improve maternal health

Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

Click to enlarge. Source: The Millennium Development Goals Report, 2015

In 1990, 380 pregnant women were dying for every 100,000 live births. As of 2013, the global maternal mortality ratio has decreased by 45 percent to 210 women per 100,000 live births. The highest gains were seen in South and Southeast Asia with a 64 percent and 57 percent reduction, respectively. Developing regions overall achieved a 46 percent reduction. Maternal survival has been aided by a one-third increase in childbirth attendance by skilled health personnel. Thus, the news in the U.N. Millennium Development Goals Report for MDG 5 is promising.

Nonetheless, progress towards improving maternal health so far falls far short of the targets set under MDG 5 and has lagged far behind the other MDGs. Additionally, global figures tend to mask regional inequalities. For example, there were 510 maternal deaths per 100,000 live births in sub-Saharan Africa compared to 190 in South Asia and 140 in Southeast Asia.

Progress in raising the proportion of births delivered with skilled personnel has been modest over the last 15 years, reflecting the lack of universal access to care. Indeed, one in four babies still being delivered without skilled personnel and wide disparities are found among regions. For example, there is a 52 percent spread between the largest rural/urban disparity across regions:

In Central Africa, 32 percent of births were attended by skilled personnel compared to 84 percent in urban areas.

In East Asia, there is no difference between urban and rural areas.

Sub-Saharan Africa and South Asia pull down the developing region average. Overall, 56 percent of births in rural areas are attended by skilled health personnel compared to 87 percent of births in urban areas.

Click to enlarge. Source: The Millennium Development Goals Report, 2015

Target 5.B: Achieve, by 2015, universal access to reproductive health
After 25 years of slow progress, only half of pregnant women in developing regions receive the minimum of four antenatal care visits recommended by the World Health Organization. Once more, coverage levels in sub-Saharan Africa and South Asia trail the other regions. Sub-Saharan Africa has barely increased from 47 percent to 49 percent of pregnant women; South Asia has the lowest coverage at 36 percent (though it increased from 23 percent). Moreover, despite having doubled contraceptive use [1] in sub-Saharan Africa from 13 to 28 percent, sub-Saharan Africa still trails all other regions.

Click to enlarge. Source: The Millennium Development Goals Report, 2015

Proven health-care interventions can prevent or manage the complications that cause maternal deaths, such as hemorrhage, infections, and high blood pressure. These complications are concentrated in sub-Saharan Africa and South Asia, accounting for 86 percent of all deaths worldwide in 2013. Use of contraceptives also contributes to maternal health by reducing unintended pregnancies, unsafe abortions, and maternal deaths.

The report tells us that contraceptive use has risen in all regions and 90 percent of users were using effective contraceptive methods. However, the unmet need is still high (24-25 percent) in sub-Saharan Africa and Oceana. Other developing regions hover around 11-14 percent unmet need, and the overall use in those regions is significantly higher than in sub-Saharan Africa and Oceana.

The adolescent birth rate shows a mixed story. While the global rate for developing regions has fallen by half (from 34 to 17 births per 1000 girls), it hides poor progress in Africa and Latin America and the Caribbean. Indeed, in three regions (Southeast Asia, the Caucasus and Central Asia, and North Africa), some of the gains in the adolescent birth rate from 2000 reversed in 2015. Moreover, progress in East Asia was stagnant over the last 15 years.

The report calls for urgently needed intensified efforts to delay childbearing and prevent unintended pregnancies among adolescents. By increasing opportunities to go to school and for paid employment, we would see an overall improved maternal and child health as well as reduced poverty, greater gender equality, and women’s empowerment.

Maternal health in the post-2015 development agenda

The new Global Goals for Sustainable Development, which are set to be approved at the Sustainable Development Summit September 25 to 27, encompasses a broader, more ambitious and inclusive health goal. Goal 3 seeks to “Ensure healthy lives and promote well-being for all at all ages.” Indeed, it seeks to reduce the global mortality ratio to fewer than 70 deaths per 100,000 live births. Under Goal 3, countries will agree to ensure, by 2030, universal access to sexual and reproductive healthcare services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs — for which the microfinance sector can be a key partner.

The report concludes on the inequalities in data availability on maternal health among and within regions. The lack of data is a key factor contributing to the unfinished MDG agenda, hampering efforts to establish priorities on national, regional, and global health. In the post-2015 period, it is imperative to have better and more data, especially concerning registration of births and deaths, in order to set adequate policy priorities, target resources more efficiently, and measure improvements.

In order to build on the successes of the MDGs and achieve Goal 3 of the SDGs, the 18th Microcredit Summit will focus on integrated health and microfinance as one of the six pathways out of poverty. Empowerment of women — which can help reduce maternal mortality more quickly and efficiently — will also be an important theme.

Footnote

[1] “Contraceptive use” is defined concerning women aged 15-49, married or in union, who are using any method of contraception

World leaders are convening in New York this week to finalize the Global Goals for Sustainable Development, an ambitious plan that will build on the successes and tackle problems where the Millennium Development Goals fell short. Freedom from Hunger and the Microcredit Summit Campaign are partnering with CARD Mutually Reinforcing Institutions (CARD MRI) to implement an 18-month project to address one of these MDG achievement gaps: maternal health in the Philippines. The project, “Healthy Mothers, Healthy Babies: Kalinga kay Inay,” is supported by an educational grant from Johnson & Johnson and will wrap up in December.

We have prepared a newsletter to let you know how things are going. To receive a copy of the newsletter, please sign up for our integrated health and microfinance news mailing list. Here is a sneak peek at the first issue of our Healthy Mothers, Healthy Babies: Kalinga kay Inay Project Newsletter.

Charyle is 32 years old and nine months pregnant with her fourth child. She attended the Davao City community health fair organized in July by CARD MRI, a Philippine microfinance institution (MFI), with partners from the MFIs for Health consortium.

Charyle was very excited to get an ultrasound. While Charyle goes monthly to a nearby health center for prenatal checkups, this was likely her first ultrasound. Charyle plans to deliver at a birthing center (an affordable alternative to a hospital for low-risk pregnancies). “I like it [the birthing center] better because it’s more personal,” she said. “I have PhilHealth, which helps with costs and point-of-care service.”

CARD has made a point to engage the local health insurance office of the Philippines’ national health insurance program, PhilHealth, in the fairs. Many women do not know the benefits or financial savings of PhilHealth membership, such as the fact that a year’s premium is less than a typical uninsured delivery. So, they provide orientation, enrollment of non-members, and other services to health fair attendees.

Irish (27) is four months pregnant with her first child. She has visited a health clinic three times already and plans to deliver at a regional hospital because she has hypertension. “So,” said Irish, “I think I will look at PhilHealth while at this health fair.”

Barrera (30) is 8 months pregnant with her fourth child. Barrera learned of the fair during her prenatal visit at the health center, which is within walking distance and offers free prenatal checkups. She said she decided to come to the fair “For the ultrasound — to be able to see my baby. It was my first time.” Berrera also plans to deliver at her local birthing center. “It is walking distance from where I live, and it is PhilHealth accredited, so free.”

Charyle, Irish, and Barrera were among 435 women who attended the two fairs; however, they were not typical in their prenatal care and delivery plans. OB/GYNs, general physicians, pediatricians, and other medical professionals provided services to these women that many normally would not be able to access or afford. In the four health fairs held so far, some 3600 pregnant and lactating women have gotten a free check-up.

What else is in the newsletter?

Increasing Healthcare Access

Through “Healthy Mothers, Healthy Babies,” 8,000 women of child bearing age (primarily pregnant and lactating women) will receive education and preventive services through five community health fairs by the end of 2015. Women from the local community and surrounding areas access maternal health products and services like urine tests, OB/GYN consults, ultrasounds, sonograms, and vitamins provided by BotiCARD (part of the CARD family). Such services are otherwise unavailable them. The next health fair will be October 2-3 in rural communities in Mindanao. ContactMharra de Mesato learn more.

What’s in the Mother and Baby Kit?

Building Capacity to Provide Health Education

What does it take to deliver maternal health education to 600,000 women? In January 2015, 17 CARD staff and 1 nurse took part in a training of trainers (ToT) on the maternal and child health education module, “Healthy Pregnancies Make Healthy Communities.” In March, four members of MFIs for Health — ASA Philippines Foundation Inc., KMBI, TSPI, and CCT — joined the Integration Workshop and ToT facilitated by CARD MRI. Learn how CARD is taking a leadership role in the Philippines to extend health products and services to more microfinance clients. ContactCassie Chandlerto learn more about the education module.

“MFIs for Health” Provide Health Services to Poor Communities

The Filipino “MFIs for Health” consortium expanded to 21 microfinance institutions (MFIs) in May when they inked a Memorandum of Agreement to provide access to health care services to poor communities. “The microfinance industry has grown so much over the past year,” Sen. Paulo Benigno “Bam” Aquino said. “It is crucial that the MFI industry should continue to innovate…and unlock more accessible opportunities that go beyond financing and bring it to our countrymen especially in the areas who have less opportunities.” Learn how the Filipino microfinance sector is mobilizing to improve the health of poor communities. Contact MAHPSecretariat@gmail.com to learn more.

With the 2013 Partnerships against Poverty Summit in the Philippines, we wrote a new chapter in the evolution of the Microcredit Summit Campaign. The 16th Microcredit Summit focused on how public-private partnerships could combine expertise from the field of microfinance with other areas to develop more efficient and sustainable services for the extreme poor.

We have since created one such collaboration in order to address the problem of stubbornly high maternal mortality rates in the Philippines. While the country has experienced strong economic growth in recent years and the government has instituted a national hospital insurance scheme, PhilHealth, maternal mortality is at 221 per 100,000 live births. The Philippines are far off track of their maternal mortality MDG of 52 deaths per 100,000 live births.

It is a long way to go from 221 to 52 in the next few months, but when offered the opportunity to scale up in a short period of time our integrated health and microfinance methodology, we (with Freedom from Hunger) jumped at the chance. In partnership with a local partner CARD MRI (the largest social development organization providing micro-financial services in the Philippines) and with the financial and strategic support of Johnson & Johnson, we are implementing the Healthy Mothers, Healthy Babies project (HMHB, or “Kalinga Kay Inay” by its name in Tagalog).

Photo credit: Cassie Chandler

How it works

The idea is simple: offer free health check-ups and behavior change education on health topics to pregnant and lactating women to create positive health outcomes. By the end of 2015, CARD and other MFIs will educate 600,000 women to improve maternal health and safe deliveries of infants, birth outcomes, and reduce preventable maternal death; and 8,000 pregnant or lactating women will be directly connected to relevant services and products. CARD and partners have held two community health fairs so far, and for many of these women, it was their very first gynecological exam.

At these health fairs, CARD sets up tents to give shade to those waiting outside. Inside the building, as the women wait for their preliminary exams (and, if necessary, ultrasounds), they learn about family planning. The volunteer health providers (doctors, OB-GYN, midwives, and others) write prescriptions for those who need medications, and BotiCARD (a CARD MRI institution) fill them for free in a tent set up outside.

CARD has found their collaboration with local government and public health units to be vital in getting higher-than-expected turnout to the fairs as well as for identifying local health providers for CARD members. Local administrators of PhilHealth have joined our January health fair and provided services to 179 health fair patients ranging from members’ renewal enrollment, new enrollment, membership updating, and printing of members’ data information.

Making these changes lasting changes

More importantly to us, through this endeavor, we are working to improve the scalability and sustainability of delivery of health education and related services to millions of women and children in the Philippines. Inspired by the 2013 Partnerships against Poverty Summit, the Campaign’s role in the HMHB project is to reach beyond the traditional microfinance actors and facilitate a partnership-building process for the “MFIs for Health” consortium, a group of 18 MFIs who are banding together to increase access for their communities to health-related products and services.

A doctor provides free checkups as part of a health outreach program in the Philippines.Photo by: CARD MRI

We are talking with several foundations, corporations, and associations to identify specific ways that they can work with us and MFIs for Health to increase access to and improve delivery of healthcare services. The Zuellig Family Foundation (ZFF) and JPHIEGO in the Philippines are two organizations that have joined forces with our alliance — whether formally or informally. They have facilitated introductions to local government units (LGUs) and the Integrated Midwives Association of the Philippines to recruit healthcare providers as volunteers for the health fair and get their help spreading the word to their patients. In fact, ZFF and CARD are working with the Rural Health Unit (RHU) in the Visayas to coincide the RHU’s “Buntis Congress” (Pregnant Women’s Congress) with CARD’s April community health fair. Through this coordination, we are pooling resources and thus gain a larger potential impact for the community.

This strategy behind HMHB, to facilitate partnerships between microfinance actors and players in other sectors, parallels efforts to create more integrated approaches to solve the most pressing needs of the extreme poor. In this case, we are addressing maternal and child health; in Ethiopia, it could be fistula and, in India, it could be non-communicable diseases.

Because MFIs meet regularly with large numbers of clients, they serve as an ideal platform to convey health information and services to clients who often build relationships of trust with their loan officers, as well as other members in their group. These exchanges can also have a replicator effect as clients are encouraged to share the information with their family members and others in their community.

By forging partnerships across sectors and bringing in non-traditional actors to microfinance, the Campaign is maximizing the best aspects of each player and (hopefully) helping the Philippines reduce their maternal mortality rate to 52 deaths per 100,000 live births.

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